|August 21 2007 | LEGAL | ARCHIVE | IPN | CONTACT | HOME | CONTENTS|
Simon Ward an intern clinical psychologist in Sydney, Australia, currently completing a Masters of Counselling Psychology, wrote thanking Ipnosis for 'its trojan work' and included the following remarks:
Since last year the atmosphere of Psychology in Australia has shifted yet again to become more entrenched in the 'Evidence-based' symptom reduction, power enforcing model. One of the developments in November last year was to include Psychological services on Medicare. That is, a doctor could refer a patient to a psychologist and the patient would receive 6 or 12 sessions of 'specialist psychological services' in a 12 month period and the government would pay the majority of the cost.
A good step.
Unfortunately the legislation includes a list of what 'psychological services' are. Surprise surprise, its CBT, they even go so far as to list the techniques. And this is the law of what the Australian Government say is the only approach psychologists may take. One wonders at the wisdom of privileging one therapy over others. Thus we now have a movement of euphemisms where CBT = Evidence based = scientific = always works.
The consequence of that development is the teaching in universities of 'Evidence Based' psychotherapy which has come to mean CBT. There is often little room for debate; there is often little room for critical thinking.
Students are often left with the implication that CBT fits all disorders and thus all people and that randomized trials are the ONLY way to establish evidence (have a look at this BMJ article which attacks that argument brilliantly).
So when I read Richard House's experiences and comments at the meeting to discuss the UK Government's white paper, I stood up and cheered!
An arguably frequent experience in Australia is that many therapists are forced to implement interventions which do not fit their own models of working or worldviews. In the case of child therapists for instance, there are numerous times CBT is inappropriate yet no other option (apart from IPT for depression only) is given.
It is my understanding that we may have lost the legal choice of what form of therapy we do. Some psychologists have left the Austalian Psychological Society due to this, some others continue to use what works for the client, that is practice based evidence, and attempt to adjust to using the prescriptive forms, language and interventions.
It appears that the Government is holding to narrow and rigid views of psychology, science and therapy without acknowledgment of the vast range of views, developments, positions, theories, debates, evidence and research which makes the profession truly innovative and vibrant.
Eg. there is no mention in the official list of interventions of Mindfulness as part of CBT. Yet mindfulness in CBT training is becoming increasingly commonplace. Does this mean that I am permitted to use this intervention, if appropriate and ethical, or am I discouraged from doing so since it is not on the list?
At the Narrative Therapy Summer School in Adelaide Michael White spoke about therapeutic directions and a few of us shared views on 'training to do therapy under the rader'.
That is, I perceive a pressure to conform to the CBT model of therapy and yet in order to adopt a Client Voice position of accountable, open, reflective, critical and client focussed practice I respectfully offer my ethical, client centred (as oppossed to model centred) interventions 'under the rader' of a dominant "evidence based" psychological movement which has received much criticism in the last decade.
(see: Norcross, J.C., Beutler, L.E., & Levant, R.F. (Eds.).(2006). Evidence-Based Practices in Mental Health: Debate and dialogue on the fundamental questions. Washington, DC: American Psychological Association.
Goodheart, C. D., Kazadin, A. E., & Sternberg, R. J. (Eds) (2006). Evidence-Based Psychotherapy. APA: Washington, DC.
for excellent reviews of the debate regarding the dangers of regulating practice to suit only one therapeutic model).
As a training psychologist I find such pressure, perceived or otherwise, very difficult and occasionally frustrating for my progress as a psychologist.
Sadly, those therapists, academics, clients, students who ask questions are not entirely popular. One is forced to be very political in the use of language and with whom one talks about these issues.